Fatty Liver

What is fatty liver?

A fatty liver is a medical condition in which fat gradually builds up in the liver. The liver is the second largest gland in the body, and it contains a certain amount of fat. However, due to a variety of factors, excess fat can begin to accumulate in the liver. It is said to be fatty if more than 5% of the liver is fat. Extra fat in the liver can cause damage to liver cells and, subsequently, may lead to liver damage.

Alternate Name

Hepatic steatosis

Causes of Fatty Liver

1. Two types of fatty liver: Non-Alcoholic Fatty Liver Disease (NAFLD) and Alcoholic Fatty Liver Disease.
2. NAFLD is very common and is mainly due to lifestyle-related conditions like

• Obesity and overeating
• Diabetes
• High cholesterol and triglycerides
• Increased blood pressure
• Sedentary lifestyle
• Certain Medications
• Family h/o of cirrhosis

1. Alcoholic fatty liver disease is caused mainly by the consumption of alcohol. However, some people develop fatty liver even if they have none of these conditions.

Signs Or Symptom of Fatty Liver

Early in the course of the disease, many patients with fatty liver have no symptoms. However, when the scarring and inflammation of the liver progresses, many patients have signs and symptoms which include:

• Discomfort in the upper right side of the abdomen (belly).
• Nausea
• Loss of appetite
• Fatigue
• Unexplained weight loss
• Weakness

In later stages,

• Yellowish discolouration of eyes and skin (Jaundice)
• Bleeding and clotting
• Swollen feet and ankles
• Ascites or fluid filled in the abdomen
• Memory loss or slurred speech, altered behaviour
• Itchy skin
• Enlarged liver
• Enlarged spleen

Risk Factor

• Obesity: Individuals with excess fat around the belly are classified as viscerally obese and are at a higher risk of developing fatty liver disease.
• Diabetes: Diabetes type 2 causes insulin resistance and increases the risk of fat deposition in the liver.
• High triglycerides: Unhealthy eating habits result in elevated levels of fat in the bloodstream (triglycerides) as well as increased fat storage in the body, including the liver.
• Increased blood pressure
• Consuming a high-carbohydrate diet.
• Increased consumption of sweetened beverages and soft drinks.

Stages of NAFLD

Stage 1: Simple fatty liver (steatosis) stage. This type is very mild, with few or no symptoms. There is no inflammation or damage to the liver cells.

Stage 2: Non-alcoholic steatohepatitis or NASH stage. At this stage, there is inflammation, which is known as hepatitis. Damaged liver cells contain extra fat, which can lead to fibrosis, cirrhosis, liver cancer, or even liver failure.

Stage 3: At this stage, the inflammation causes scar tissue to form around liver cells and blood vessels, but the liver can still function normally. This is referred to as fibrosis.

Stage 4: After years of inflammation and scar tissue buildup, the most severe stage of the fatty liver occurs. Cirrhosis at this stage causes the liver to enlarge or shrink, and scarring becomes too extensive for the liver to function properly. At this point, the damage is permanent and irreversible, and it can result in liver failure, liver cancer, and even be fatal.

Pathophysiology

Due to insulin resistance, there is an increase in circulating free fatty acids, a decrease in hepatic glycogen storage, and an increase in gluconeogenesis. This results in increased intrahepatic lipid accumulation (steatosis) and triglyceride secretion. The extra lipid is transported to adipose tissue, where it is stored as fat. Inflammation and swelling progress the disease from NAFL to NASH, resulting in fibrosis and hepatocellular carcinoma.

Possible Complication

A fatty liver in the early stage could be completely reversible. However, if a patient continues to have excess fat in the liver, this can lead to complete scarring of the liver known as sclerosis. This can lead to cirrhosis of the liver, liver failure, liver cancer, and the need for liver transplantation.

Typical Test

Most of the time, this is only detected when a patient undergoes an ultrasound of the abdomen.

To confirm the disease, the following tests are recommended,

• Blood tests which include lipid profile and complete LFT
• Imaging modalities such as using abdomen, CT scan, and MR elastography /fibroscan are advised
• Fibroscan or MRE can capture the amount of fat in the liver as well as to detect the extent of damage Occasionally, a liver biopsy may be required.

Expected Prognosis

Since there are no symptoms in the early stages of the issue, it is necessary to diagnose this disease at a very early stage. If detected and controlled in the early stages, the prognosis is very good. For individuals who reach the NASH stage, the problem can increase further and can lead to liver damage.
 

Natural Progression

Most of the time, the fatty liver does not cause any issues. Plain steatosis, also known as simple steatosis, does not cause swelling in liver cells or any harm for many years. Because of fat accumulation, the disease may progress gradually and cause swelling or inflammation in the liver cells. This is referred to as NASH (Non-alcoholic steatohepatitis). Cirrhosis of the liver can develop gradually as a result of scarring in the liver. Liver failure can occur in rare cases.

Since this is primarily a lifestyle disease, primary prevention involves maintaining a healthy lifestyle such as,

• Avoid alcohol intake.
• Control obesity and maintain a healthy weight
• Keep a check on sugar levels.
• Regular health check-ups, which include blood tests and ultrasound of the abdomen

Prevention

Once detected, it is important to prevent liver damage by identifying and treating the underlying cause.

• Reduce weight
• Diabetes mellitus must be managed.
• Take regular medications if any viral infections like B and C.
• Eat a nutritious diet and avoid eating junk food.
• Consult a specialist regularly.
• In alcohol-induced fatty liver, stop drinking alcohol. The doctor may recommend that you participate in a de-addiction program.
• Regular health checks and follow-ups are required.
• Take any medications that have been prescribed by a specialist.

Possible Fatty Liver Treatment

There is no specific fatty liver treatment, however, you must be aware of the following:

• The most important step is to control the risk factors such as high cholesterol, controlling blood sugar, and losing weight for obese individuals.
• This disease can be prevented as it arises from lifestyle issues.

The disease can be controlled

• by losing around 5 to 10% of body weight.
• A healthy lifestyle includes daily brisk walking of around 45 minutes.
• Avoid fried foods, sweets, refined sugars, rice, and potatoes.
• Increase vegetables and salads in the diet.
• Decrease calorie consumption by around 30%
• Regular health checks and follow-ups as required.
• avoiding over the counter medications
• Take any medications that have been prescribed by a specialist. Medications are primarily used to treat associated symptoms.